| Objective:The recurrence rate of patients with tongue squamous cell carcinoma is high and the prognosis is poor.The objective of this study is to explore the related factors affecting the recurrence and survival rate of patients with tongue squamous cell carcinoma through retrospective analysis,so as to optimize the treatment methods,reduce the recurrence rate and prolong the survival time of patients.Methods:A total of 80 patients with tongue squamous cell carcinoma,who met the inclusion and exclusion criteria,and who underwent surgery for the first time in department of Head and Neck Surgery in our hospital from January 2013 to June 2022 were collected.The basic information,clinicopathological data,treatment data and follow-up data were collected,.SPSS 27.0 software was used for statistical analysis of the data.Kaplan-Meier method was used to analyze the Overall Survival rate(OS)and disease-free survival rate(DFS)of tongue cancer patients.Log-rank univariate analysis and Cox regression multivariate analysis were used to examine the risk factors affecting OS and DFS respectively.P<0.05 was considered statistically significant.Results:A total of 80 patients with tongue squamous cell carcinoma were collected within the above time frame,including 41 males and 39 females.The mean age was 54.7±13.9 years.The median follow-up time was 22.5 months(range 6-109 months).During the follow-up period,29 cases had recurrence after operation.The overall recurrence rate was 38.8%.The average recurrence time was 8.9 months,and the median recurrence time was 6.0 months.28 patients recurred within 2 years after operation,accounting for 96.6%of the total recurrence.A total of 31 patients died,and the time of death was 6-90 months,with an average of 24.7 months and a median of 15.0 months.Kaplan-Meier survival analysis showed that the 1-,3-,and 5-year OS rates of 80 patients with tongue squamous cell carcinoma were 85.7%%,65.6%,and 51.5%,respectively.The 1-,3-,and 5-year DFS were 66.6%,60.8%,and 60.8%,respectively.For DFS,Log-rank test univariate analysis showed that tumor perineural invasion,pT stage,pN stage and pTNM stage were related factors affecting postoperative recurrence in patients with tongue squamous cell carcinoma(P<0.05).Multivariate Cox regression analysis showed that pN stage and pTNM stage were independent influencing factors for DFS in patients with tongue squamous cell carcinoma after surgery.The recurrence rates of pN1,pN2 and pN3 patients were 2.988,4.597 and 6.046 times higher than those of pN0 patients,respectively.The recurrence rates of stage Ⅱ,Ⅲ,ⅣA and ⅣB patients were 2.989 times,6.845 times,10.453 times and 13.721 times of that of stage I patients,respectively.For OS,Log-rank test univariate analysis showed that age(classified as<45 years old and ≥45 years old),tumor perineural invasion,pT stage,pN stage and pTNM stage were related factors affecting the postoperative survival rate of patients with tongue squamous cell carcinoma(P<0.05).Cox regression multivariate analysis showed that pT stage,pN stage and pTNM stage were independent influencing factors for OS of patients with tongue squamous cell carcinoma after surgery.The mortality rates of pT2 and pT3 patients were 3.132 and 3.839 times higher than those of pT1 patients,respectively.The mortality of pN1,pN2 and pN3 patients was 4.680,3.104 and 3.399 times higher than that of pN0 patients,respectively.The mortality of stageⅡ,Ⅲ,ⅣA and ⅣB patients was 2.106,7.617,9.417 and 10.286 times higher than that of stage I patients,respectively.The effect of neck lymph node dissection on DFS and OS of 56 pN0 patients was analyzed.Univariate analysis by Log-rank test showed that in patients with pN0(n=56),pT1 in pN0(n=28),and pT2 in pN0(n=23),neck lymph node dissection had no significant effect on DFS and OS(DFS:P=0.613,0.630,and 0.112,respectively)(OS:P=0.874,0.491,0.170 respectively).For patients with pT3(n=5),the P value could not be calculated because the number of patients without neck dissection was 0Analysis of 29 patients with recurrence:18 cases of neck recurrence,3 cases of primary site recurrence,8 cases of both primary site and neck recurrence.Log-rank test univariate analysis showed that:Proper treatment after recurrence(including salvage surgery,adjuvant chemoradiotherapy,and targeted therapy)significantly affected the survival of patients(P=0.007).The 1-year OS of patients without treatment after recurrence(n=15)was 40.0%,while the 1-year OS of patients with treatment after recurrence(n=14)was 85.7%.Conclusion:1.Recurrence is an independent risk factor affecting the prognosis of patients with tongue squamous cell carcinoma.Neck recurrence is more common than primary recurrence,and the peak of recurrence is within 2 years after surgery.Patients who actively intervene after recurrence benefit more.2.Peripheral nerve invasion is a risk factor affecting the prognosis of patients with tongue squamous cell carcinoma.Patients with peripheral nerve invasion have higher recurrence rate and mortality.3.Cervical lymph node metastasis and pTNM stage are independent risk factors affecting the prognosis of patients with tongue squamous cell carcinoma.The higher the cervical lymph node metastasis and tumor stage,the higher the risk of recurrence and death in patients with tongue squamous cell carcinoma. |
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